Doctor-Moms, This Is Our Job

Finally, a cause we can all agree to take action on. We means everyone: Liberals and Conservatives, Democrats and Republicans, Christians and Jews and Muslims and Atheists and everyone in between. Follow to the end for specific, easy actions you as a physician and a mother can take to help stop this morally repugnant horror.

The issue? Around the world, we are seeing a horrific trend: children are increasingly being used as tools in political conflict. In Syria, children are used as human shields. In Afghanistan, children are recruited and used as soldiers. In Nigeria, children are recruited as suicide bombers. In Myanmar, children are tortured to send a political message.

Here in the United States, we take children as political hostages.

This is no exaggeration nor overstatement. This Saturday, our President stated that he is using  migrant children taken from their families as a political bargaining chip. Despite his repeated insistence, there is no law nor policy in place stating that migrant families should be separated at the border, only President Trump's personal mandate.

How could such a horrible thing happen here, in our democracy? In Spring 2017, Trump's Homeland Security Advisor John Kelly proposed separating all children from their parents as they sought shelter, “in order to deter more movement along this terribly dangerous network”, as reported in last week's New York Times.

More recently, Trump's senior policy advisor Stephen Miller reiterated that this is all Trump's doing: 

“It was a simple decision by the administration to have a zero tolerance policy for illegal entry, period. The message is that no one is exempt from immigration law.”
 
It is now well-documented for the world to see and judge. In using children as political hostages, our country has stooped to the same lows as terrorists and dictatorships in Syria, Afghanistan, Nigeria, Laos, and Myanmar.

Of course there is growing outrage against Trump's disgusting agenda. Many Republicans leaders are stepping forward to condemn this administration's inhumane actions, and not only moderate stalwarts like former First Lady Bush and Senator Susan Collins of Maine. Even Senator Lindsey Graham of South Carolina has gone on record, stating "President Trump could stop this policy with a phone call",  as Monday morning's New York Times reports.

While he is unlikely to take any action, we can.

We are mothers and doctors. We are uniquely positioned to comprehend the psychological damage inflicted upon children who are forcibly removed from their caregivers. The American Academy of Pediatrics has vehemently opposed this as policy since it was first mentioned by Trump's administration last Spring, based on the known grave consequences to child development. Pediatricians are speaking out. AAP president Colleen Kraft described the heartbreaking grief of a toddler she witnessed at one detention center, and explained the effects of harmful toxic stress on children.

As the AAP's formal statement on The Detention of Immigrant Children recognizes:

"In accordance with internationally accepted rights of the child, immigrant and refugee children should be treated with dignity and respect and should not be exposed to conditions that may harm or traumatize them. The Department of Homeland Security facilities do not meet the basic standards for the care of children in residential settings."

The American Psychological Association has also written a letter to the Trump administration in opposition to the policy:

"Families fleeing their homes to seek sanctuary in the United States are already under a tremendous amount of stress. Sudden and unexpected family separation, such as separating families at the border, can add to that stress, leading to emotional trauma in children. Research also suggests that the longer that parents and children are separated, the greater the reported symptoms of anxiety and depression are for children."

Yes, it's pretty clear that ripping innocent, frightened children from their parents and locking them in chain link cages is not in accordance with internationally accepted rights of the child. So what can we do about it?

As little or as much as you want. This can be simply clicking on a link to sign a petition or donate to a vetted charity, to calling your representatives, to writing an article for a local newspaper or blog... It's up to you. Here are some suggestions (and I personally did every single one of these this lovely Monday morning before my clinic started):

SIGN: 
Petition to Donald Trump to stop separating families at the border: https://actionnetwork.org/petitions/where-are-the-children

Petition to the Department of Homeland Security to stop separating families at the border: https://www.change.org/p/department-of-homeland-security-stop-tearing-families-apart

Petition to Secretary of the Department of Homeland Security to stop separating families at the border: https://www.change.org/p/keep-them-together-stop-separating-children-from-their-families-at-the-u-s-border

DONATE:
KIND (Kids In Need of Defense) is a nonprofit that provides legal assistance children who would otherwise stand in court alone. 

The Florence Project is a nonprofit that provides legal assistance to political detainees, including children, in Arizona.

The Asylum Seeker Advocacy Project is a nonprofit that provides legal assistance to refugees feeling violence seeking safety here int he U.S.

RAICES is a nonprofit that provides legal assistance to detainees and refugees, including children, in Texas.

Al Otro Lado is a binational nonprofit that provides legal assistance to families who have been separated, navigating the legal systems of Mexico and the United States to bring them back together. They also help deportees who have been abandoned in Mexico with resources including medical care.

PROTEST:
Families Belong Together is organizing rallies and protests in opposition to separating families at the border. Check out their website to see what's happening next near you.

CALL:
This is actually one of the most powerful things you can do. Call your representatives using any of the below easy methods. You'll probably get an answering machine, but if you get the machine or a person, say "My name is (your name) and I am opposed to separating families at the border. I am from (your zip code) in (your state). I do not need a response.":

Find your representatives in the House and then find their office phone number, and call.

Find your representatives in the Senate  and then find their office phone number, and call.

Or just call the Capitol operator: 202-224-3121. This number will direct you to the Capitol switchboard. When you call, ask to be connected to your senator or representative. The operator will direct your call to their office.

Pending Legislation on this includes The Keep Families Together Act and The Help Separated Children Act . 

SHARE: 
Whichever of these relatively small actions you take, TALK about it, SHARE on social media, PUBLICIZE the cause. This is really powerful.

WRITE: You are a doctor. You have a platform. Your voice is heard. Please consider writing a letter to your editor, even if it's a small town newspaper. Consider writing an op-ed for a news outlet. Consider posting on a political website, as Sanjiv Sriram, MD did. Consider writing a guest post for a blog. I accept guest posts at my own personal blog www.generallymedicine.com , and the editor here at Mothers in Medicine does as well. Kevin, MD is another great place for physicians to share their educated, intelligent thoughts.

Whatever you do, DO SOMETHING. The policy of using children as a political tool is morally repugnant, and we as doctor-moms know this better than anyone. Please help to stop this moral slide into evil.

Stumbling Through The March For Our Lives With Little Kids

Genmedmom here.

As a primary care physician with strong public health and clinical research roots, and as a politically engaged mom with serious concerns about our kids' futures, it made perfect sense to take our kids to the March 24th March for Our Lives Boston.

One complication: Hubby and I have been shielding them from the news, especially school shootings news. Babyboy is extremely sensitive to the topic of death, dying, and violence. He'll have "bad memories" for weeks after hearing or witnessing something along gun violence lines. This may be a normal little kid thing rather than an autism thing; they're only seven and six years old, after all.

Given all of this, it was actually very difficult to explain why were marching.

The Women's March and the March for Science were so, so much easier! Yesterday, Hubby and I found ourselves searching for explanatory phrases that didn't include references to school shooting deaths or the words "being shot" or "being killed". We ended up stammering, stumbling, and not successfully conveying the point.

Many organizations have offered guidance on how to talk to little kids about tragic events and disasters, such as the American Academy of Pediatrics and the American Psychological Institution. Major news outlets regularly publish advice about talking to children specifically about school shootings (which is definitely a statement about the states of affairs in this country). Two recent articles on TODAY.com and Cnn.com are actually pretty helpful.

So, this is something we clearly need to work on, as the kids' school runs lockdown drills and the #GunControlNow, #Enough, #Gunsense, and #MomsDemandAction movements spur debate and action.

Regardless, their taking part in a massive live social change movement is a powerful lesson. We emphasized that in many other countries, citizens aren't allowed to gather and protest, that we are very lucky to have this privilege, and we have to use it.

Overall, I'm glad that we took them and that they got to see freedom of speech, political activism, public health awareness, and social altruism, all at once and in person.

What's This Week Been Like For You?

I’m sure we all have an opinion about the election outcome; most likely, a strong one. I was following with intense anticipation as a Canadian. I am utterly despondent with the result. The day after, I met a friend for coffee and together we tried to process the reality. It felt much like the morning after 9/11, where we knew we were facing a ‘new world’ and an uncertain future. 

Our national public radio station’s coverage was filled with interviews with Americans relaying their uncertainties about the future. One gentleman felt a sense of betrayal by his neighbours; that he did not feel he really knew his city as he thought he did. I know that some of you are heartbroken, as I am. Others may be elated, or at least satisfied with the outcome. Some of you may feel conflicted. Still others may be Republicans who feel dismayed that Trump was their candidate. Maybe none of these captures your sentiments. I know many people are struggling to talk to their children about the outcome. Many American citizens and residents of colour and other vulnerable populations are especially worried about the “Trump effect” on their children, and perhaps some of you are seeing its effects in your daily life in medicine. In Family Medicine, it's not uncommon for some patients to bring up political topics, but I try to stay pretty balanced and general.  Personally, I found inspiration here, which cites this great article about talking to your kids about the result. Reading personal accounts and opinion pieces by those who are processing the results thoughtfully is helping me deal with the result. 

I realize that politics in general, and this election in particular, can be polarizing to discuss, and I know this blog does a great job of being a safe space. A refuge from the constant barrage that was so consuming during this campaign, perhaps. I think we can maintain that safe space by respectfully sharing our own personal experiences, fears, and worries. Because no matter your political stripes, I think it’s fair to say that the months ahead are uncertain for the United States, and the world.  

I have great faith in the American people, and the American system, to uphold their democratic values. I believe that most people are decent and that political and social tides ebb and flow throughout history. Let's help one another navigate the best way forward for our families, communities, countries, and the world. 

Talking Politics and Public Health With Patients- Is It OK?

Genmedmom here.

My Friday morning clinic was slow. There were two last-minute cancellations and a no-show. So when Mrs. Smith* came in for her physical, I wasn't in a rush, and we had some time to chat.

We talked about her recent hip replacement, and how thrilled she was to be finally pain-free and physically mobile, so that she could help care for her grandchildren again. Her face was bright with joy as she spoke of the beach and playground and the zoo and how much she loved experiencing the world with her two young grandchildren.

But she hesitated and frowned as she remarked: "I watch the news, and with everything going on today, I worry about them. We're moving in the wrong direction as a society. I mean, look at this presidential election, isn't it ridiculous, to think that a person so flawed could end up as a candidate? I'm frightened for their future."

Then she asked, "Your children are little, what do you think about all this craziness, do you lose sleep over it too? How can we protect them from it all?"

Up to that point, we had been slowly moving through the physical exam, and I had been wordlessly responding to her lighthearted description of her days as Nana the nanny with laughter, positive nods and smiles… When she admitted her fears, I reflected back grim countenance and shook my head, as if to mime What a shame, what a shame, but I didn't say anything. 

I had no idea at this point what her specific views were. Her comments could reflect the opinions of anyone anywhere on the political spectrum. The flawed candidate she was referring to could be either Democrat or Republican. I didn't want to say anything potentially inflammatory, or even mildly awkward.

But she sat there awaiting my opinion.

Her questions hung there, between us, as I shook my head and tried to think of something to say.

Is her idea of crazy the same as my idea of crazy?

Does she want to protect her grandkids from the same things that I want to protect my kids from?

Do I really want to talk about this? And, is it appropriate?

I thought about my morning commute. There's an app on my phone that pulls articles from all the news sources I choose, and I have chosen just about every possible news source, even those representing the far other side of my political leanings. I like to know what's going on, through all the looking glasses. I read it all on the train on the way to work.

For months now, the news has been increasingly disturbing. Mass shootings, terror attacks, senseless violence against minorities and law enforcement alike, war abroad, mass displacement… it's all horrible.

But what's worse in my eyes is that here in the land of equality, in a country founded on sound principles and thoughtful discourse, we are witnessing the ugly rise of a potential dictator. Here is a divisive fascist whose behavior already mirrors that of the worst dictators in history. Historians and scholars continue to make observations and deliver warnings. This kind of a man, this kind of rhetoric, these lies and sick ideas, are what have led to genocide and war in the past. And if that isn't a public health issue, I don't know what is.

So, what do I think about all this craziness? I think about it all the time. It makes me sick to my stomach. But specifically WHAT I think about it may not be appropriate to discuss with patients. I believe that the candidate on the right is a bona fide public health issue, on many levels. But so is gun control, and beyond asking patients if they have a gun in the house and how it is stored as a basic home safety screening question, I don't get into the issue with anyone.

Perhaps we should. Perhaps we, as educated professionals with a sworn oath to promote the health and well-being of our patients- ALL of our patients- should be open about our views on matters that effect patient safety. Maybe that could be a means of educating the public on important issues, like gun control.... and rhetoric that promotes violence.

This all went through my mind...

So, what did I say?

I murmured "I know, it's really scary…", paused and smiled and declared, cheerfully: "Your grandkids are so lucky that they have you. I'm so happy for you that the hip surgery had such a good outcome."

She smiled back, and we went on as if nothing at all was wrong with the world.



*Patient identifiers such as social history and medical issues altered.

Conversations with My Daughter

This morning as she read the newspaper report of yet another shooting death.

Why does this keep happening, Mom?

It's complicated.

After all those kids were killed in Newtown, you'd think someone would do something. And black kids get killed all the time - way more often than white kids.

Yes.

Can't the President do something to fix this? To stop this? Can he make guns illegal?

You learned about checks and balances in the Constitution, right? The President can't act on his own.

So Congress needs to make a law?

Yes. And the National Rifle Association spends a lot of money to make sure they don't pass laws limiting access to guns.

Do you think we should do something?

Yes. Your dad and I do what we can to support politicians who would pass reasonable controls - to treat a gun like a car. Before you can get a driver's license, you'll need to pass two tests and practice for at least 65 hours, and we need to have insurance.

I guess criminals will always be able to get guns. They can steal them.

Yes. I don't think we'll completely stop gun-related crime. I do think we can reduce the number of accidental shootings and suicides by gun, though, and I think we should.

Well, the way it is just isn't right.

24/7

Mamapop had a great discussion Thursday about feminism, and how it applies to politics, specifically Sarah Palin. Feminist is not one of the labels I apply to myself (like juliaink). Just don’t consider myself a pioneer in moving the cause of women forward. I also don’t tag myself as a political animal. However, this election has me fired up because I feel that the items the media has picked up and discussed are issues in my back yard.

As women in medicine and specifically mothers in medicine, we have a unique perspective. My occupation is 24/7. I share call with other physicians, now, although I was once a solo practitioner. The ownership part of my practice is still there seven days a week and requires maintenance whether it is employee reviews I need to write, maintenance of the facilities or just a late night security call. Being a physician is a 24/7 job whether I’m on call or not – and I suspect it may be that way for my fellow MIM writers. Have you fielded a phone call from a worried neighbor or family member because you have MD or DO (or RN, PA, NP) after you name?

Mothering, Fathering and Parenting are also 24/7 jobs. Even with my two healthy children, the balance is precarious and dynamic. I can only imagine what adding intense media coverage, decision making for 300+ million citizens, and overlapping passport stamps would do to my stress level. It’s not that the VP (or presidency, for that matter) job isn’t compatible with parenthood. It is. I’m not sure the job that will require 110% focus seven days a week (or at least this is what I expect out of elected leaders ) is balanceable with children that need their parents as much as 2 of the 5 Palin kids will need their parents in the coming months.

The Elephant in the Room

I, like many women, and perhaps like physicians in general, am averse to political activism. Medical problems have, or we are taught to think they have, right answers. Controversy and disagreement are uncomfortable to us, implying that our judgment or knowledge is somehow at fault. Even the formal exercise of an M and M conference does not help us recognize and accept legitimate differences; at the end of the disagreement, the pathologist is there to provide the single right answer. And as women, we want to make others feel accepted and comfortable. So I am reluctant to take a political position in this blog. Some of my best friends, etc....

I am not about to rant on either candidate, but I do want to share my dismay at some of the health care issues that are going to be affected by the outcome of the next election. A friend of mine in Hawaii wrote to me that blue cross/blue shield in her state requires women to pay higher premiums than men--and gets away with it! Yes, women have expenses related to reproductive care that men don't, and yes, we live longer. But the whole idea of health insurance is to spread risk fairly through a population. Differential pricing by gender implies that men are the true representatives of the population and women somehow deviant from the norm (despite being an absolute majority). This stands the very edifice of health insurance on its head.

Beyond reproductive health care services like abortion and contraception, adequate insurance for the elderly, including nursing and other support services, are also "women's issues." When insurance fails to cover services, it is typically women--wives and daughters--who pick up the responsibilties of caregiving. When insurance does not pay for services for children, it is mothers who step in fill the vacuum. Now that women are more productive in work outside the home, the economic costs of us having to cut back our own work to become caregivers are huge, and rarely acknowledged.

The underlying problem is one of state/federal conflict, not necessarily Democratic/Republican differences. The regulation of private health insurance is a state rather than a federal function. Many insurance companies have budgets--and therefore political clout--larger than the state governments that regulate them. Only the federal government is large enough and strong enough to rein in the rogue health insurance industry. Personalities and records aside, this mother in medicine is going to vote for the candidate who believes in using the power of government to regulate crucial service institutions directly, not through byzantine manipulations of the tax code. Three guesses as to who that will be.